Health exchange board faces tight deadline

Dennis Domrzalski, Reporter- Albuquerque Business First

The New Mexico Health Insurance Exchange has no shortage of doctors and people with health insurance experience.

Board members include Dr. Martin Hickey, former CEO of the Lovelace Hospital and Lovelace Health Plan and now president and CEO of New Mexico Health Connections, the state’s startup, nonprofit health plan, and Ben Slocum, CEO of Lovelace Health Plan.

Also on the board is Sidonie Squier, secretary of the New Mexico Human Services Department.Including Hickey, there are four doctors on the board. The others are Dr. James Damron, staff radiologist in the department of radiology at University of New Mexico School of Medicine; Dr. J. Deane Waldman, a professor of pediatrics at UNM’s Health Sciences Center; and Dr. Larry Leaming, respiratory therapist and CEO of Roosevelt General Hospital.

Whether the 13-member board will be able to get the state’s insurance exchange operational by Oct. 1 as required by the federal Affordable Care Act is a question.

Sam Gibbs III, president of government systems for eHealth.com, one of the nation’s largest private health insurance exchanges, said it’s questionable whether any of the 19 states — New Mexico included — that have committed to building their own exchanges will meet the Oct. 1 deadline.

The board will have to hire an executive director and decide whether to continue the work of building the exchange that was started by the New Mexico Health Care Alliance, or start over.

The Alliance, which was working with a $34 million federal grant, had been set to name a vendor in February to build the exchange.

That work was halted when some state lawmakers said New Mexico couldn’t proceed with its exchange without enabling legislation. The legislation was passed and signed by Gov. Susana Martinez at the end of March.

But precious time was lost in building the exchange, as the Alliance also halted the effort to seek a second, $100 million federal grant for startup efforts.

The NMHIE board will also have to determine how the exchange will be funded. All exchanges will be funded by the feds in 2014, but in 2015, they have to be self-sufficient, Gibbs said. One option open to the board would be to levy a surcharge on insurance companies that sell on the exchange, Gibbs added.

If New Mexico or any other state does not meet the Oct. 1 deadline, the federal government is set to run the exchanges until the states get theirs operational.

The exchanges are supposed to be online marketplaces where individuals and small businesses will be able to buy health insurance.

A few questions and answers about exchanges

Sam Gibbs III is the president of government systems for eHealth.com, a private, online insurance exchange that has helped more than 3 million people buy insurance since it was founded in 1999. Gibbs was in New Mexico recently to meet with Gov. Susana Martinez to talk about how eHealth could help the state build its exchange.

Why would businesses be interested in buying insurance on the exchange or having their employees do so?

Small companies might not even have a human resources person, let alone an expert on health insurance. The exchanges qualify employees, determine whether they will be eligible for federal subsidies and such. It takes all of the burden of doing those things off the employer. For small businesses, meaning those with fewer than 50 employees, that is a big deal.

How long will it take individuals and businesses to get used to shopping on the exchanges?

They are supposed to be operational in 2014, but it will take at least a decade for people to truly get used to them.

What other benefits will the exchanges offer?

They will help standardize things in the health care world. For instance, enrollment will be standardized across the country. That means whatever state you’re in, you’ll have the same enrollment form. Benefits and plans will also be standardized.